Written by Clay Smith
With the combined weight of twelve RCTs, ultrasound-guided LP was shown to be superior to landmark-guided LP in multiple ways.
Why does this matter?
Point-of-care ultrasound (u/s) is used for many ED procedures, such as central line placement, abscess drainage, paracentesis, thoracentesis, and more. Numerous studies have been published about its use for LP. This is a compilation of those with the highest quality.
Someone needs to learn this (he says sheepishly)
This was a meta-analysis of 12 RCTs, 957 total patients, that found the primary outcome of success was 90% with ultrasound guidance and 81.4% when using landmarks only; risk difference 8.9%, NNT = 11. Other secondary outcomes also showed improvement with u/s, including half the number of traumatic taps, 1-minute shorter procedure time, fewer passes with the needle, and reduction in pain by almost half. When adult and pediatric studies were separated and pooled, there remained a trend for each toward improved overall success with u/s, but the results were no longer statistically significant. However, statistical significance remained for the other secondary outcomes when adult-only or pediatric-only studies were pooled.
The best way to do u/s-guided LP is in this video.
I would recommend watching them all.
Ultrasound-Assisted Lumbar Punctures: A Systematic Review and Meta-Analysis. Acad Emerg Med. 2018 Aug 21. doi: 10.1111/acem.13558. [Epub ahead of print]
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